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Blue Cross and Blue Shield of Illinois, Montana, N Coding Investigation Specialist - PIPELINE/ WFH (IL, NM, OK, TX) in Chicago, Illinois


Job Purpose:

This position is responsible for auditing clinical, billing, coding and lowest cost setting reviews for services pre and post payment utilizing medical, contractual, legislative, policy, and other information to validate claims submitted and billed; conducting research; preparing documentation of findings and consulting with special investigation and the Affordability of care area as needed. Coordinating with all departments involved in each case required such as Medical Director Special Investigations, Customer Service, PASS, Network Management, Marketing, Case Management, Medical Review, Legal, Pricing and Database.

Required Job Qualifications:

  • Bachelor degree or 4 years of business experience.

  • Certified Coding Certification, or acquire within 24 months of hire.

  • 3 years of experience in claims processing operations, and reporting systems, including 2 years of experience in auditing or developing computer system reports..

  • Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation.

  • Knowledge with claims processes and claims processing systems.

  • PC proficiency to include Microsoft Word and Excel and health insurance databases.

  • Clear and concise verbal and written communication skills to communicate to physicians, members and providers and compose and explain document findings.

  • Organizational skills and prioritization skills.


Location: IL - Chicago, NM - Albuquerque, OK - Tulsa, TX - Richardson

Activation Date: Thursday, October 14, 2021

Expiration Date: Saturday, October 30, 2021

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